NHS diabetes care is ‘inadequate’ and some patients come to further harm due to poor care in hospital, a leading specialist says.Dr Gerry Rayman, national clinical lead for inpatient diabetes, warned many hospitals had no specialist diabetes nurse. He said many hospital patients had diabetes, and called the situation ‘quite alarming’.
Diabetes accounts for 11% of all NHS inpatient expenditure, and costs the service around £23.7 billion last year, a figure projected to increase to just under £40 billion by 2035.

Diabetes that is not controlled can cause many serious long-term problems

Uncontrolled diabetes is the most common cause of blindness in people of working age.

People with diabetes are also 15% more likely to have an amputation than people without the condition.

In Type 2 diabetes, not enough insulin is produced or the insulin that is made by the body does not work properly.

It tends to affect people as they get older and usually appears after the age of 40, but increasingly is seen in younger, overweight people. It accounts for 90% of all cases.

Type 1 diabetes, a condition which usually means insulin cannot be produced at all, is responsible for the other 10%.

Adrian Sanders, chair of the all-party parliamentary group for diabetes, claimed there was plenty of evidence out there to support Dr Rayman’s assessment.

He said the government was aware that a disproportionate number of people occupying hospital beds have diabetes, and their hospital stays are longer.

He said the government – and the last Labour administration – had encouraged more support for people with diabetes in primary care.

“That’s actually a very good policy for people whose condition doesn’t present complications or specialisms. And that’s why you need specialist care for those who present with specialist problems.”

Barbara Young, chief executive at Diabetes UK, said diabetes was a serious condition which could lead to devastating long term complications including blindness, kidney failure and amputations.

She said: “The tragedy is that for many people with diabetes, complications could have been avoided if the health checks were in place to spot any signs and if the appropriate care and treatment were applied.

“For example, up to 80% of amputation cases due to diabetes could be avoided if problems are identified early enough and treated appropriately.”

The gap between male and female life expectancy is closing and men could catch up by 2030 according to research at the Office for National Statistics.Prof Les Mayhew said the difference between the sexes peaked at nearly six years in the 1970s.

Life expectancy is going up all round, but the rates for men are increasing faster. Plummeting smoking rates in men are thought to explain a lot of the change.

Prof Mayhew, a professor of statistics at Cass Business School, analysed life expectancy data in England and Wales. He was working out how long 30-year-olds could expect to live.

His findings show men laguishing far behind for decades, but now starting to get closer to women. If current trends continue, Prof Mayhew predicts, both sexes could, on average, be living to the age of 87 in 2030.

He said: “What’s interesting at the moment is that in the last 20 years or so, male life expectancy at 30 has jumped by about six years and if it jumps by the same amount in the next 20 years it will converge with female life expectancy.”

The reason could be down to men living a healthier lifestyle. “One of the main reasons, I think, is the trend in the prevalence of smoking. Smoking took off after 1920 in the male population and at its high about 80% of males smoked.

“This was reflected in more divergence in the life expectancy, so by the time you get to about 1970 it was at its peak – the difference in life expectancy was about 5.7 years.”

Other factors are thought to be safer, more office-based, jobs. Millions of men used to work in hazardous occupations such as coal mining. Healthcare has meant more men live longer as well. People with heart disease, which is more common in men, can expect to live much longer than they did a few decades ago.

By contrast, women started smoking later than men. Rates of lung cancer are still increasing in women, but are falling fast in men.

A boy and a girl born on the same day will still not have the same life expectancies, as the study looked only at people who had already reached 30. Boys are more likely to die in their first year of life and are more likely to take up dangerous sports or be involved in fatal accidents.

Prostate cancer symptoms are unfortunately difficult to spot in the early stages of growth.Only when the cancer has advanced will symptoms usually appear- which is a bad cancer sign and contributes to the approximately 10,000 deaths in the UK every year.

If you experience any of the following symptoms, you must see a medical professional immediately:

the prescence of blood in urine and/ or semen

pain or burning sensation when urinating

erectile dysfunction (inability to have or sustain an erection)

uncomfortable or painful ejaculation

in the upper thighs, hips, or lower back, a frequent pain or stiffness

a general pain in the prostate area

a need to urinate frequently, especially at nighttime

difficulty in urinating, both in starting or holding back

interrupted or weak flow of urine

There are several Risk Factors associated with Prostate Cancer:

Age – For men with over fifty years of age, prostate cancer is most common.

Family history – It is also an important indicator. If you have a close male relative who has suffered or is suffering from the disease, you are twice as probable to be diagnosed with prostate cancer yourself.

Nationality – Your nationality and racial genetics may also play a part. Studies show, for example, that African-Americans are most at risk, followed by Americans and Europeans. Asians (particularly those that live in the East and Southeast portions of the continent) are the least at risk.

Lifestyle – Even though, the evidence in often conflicting, in the development of prostate cancer, an individual’s lifestyle, and diet may also play an important part.

At present, while prostate cancer is not an avoidable disease, it can be mitigated by alterations in a person’s food consumption and general way of life.

The most commonly employed method of testing for prostate cancer is a basic prostate exam.

It involves a physician inserting a gloved, lubricated finger into the rectum so that the physician can feel the prostate, which is located a few inches up from the rectum. A healthy prostate feels firm; if prostate cancer is present, the prostate may have hard spots on it.

For those who are squeamish towards this type of testing, an alternative method is sometimes used.

Known as a prostate cancer PSA level test, blood is taken from the patient and screened for prostate-specific-antigen levels.

Prostate-specific-antigens are present in all men, but those with prostate cancer often have a heightened level of the antigen.

Alternatively men with the BRCA1 gene have a one in 11 chance of developing prostate cancer by the age of 65, it was found.

Other tests such as X-rays and bone scans may also be useful in detecting the cancer and determining the extent to which it has spread.

Global efforts to cut the number of deaths from measles have fallen short of World Health Organization (WHO) targets.An analysis published in the Lancet said deaths had fallen by 74% between 2000 and 2010, but the target was 90%.

Outbreaks in Africa and delays in vaccination programmes in India have stalled progress, researchers say.

A new campaign to tackle the disease has been launched, which will combine measles and rubella jabs.

In 2000 there were 535,300 deaths from measles. This fell to 139,300 deaths in 2010, according to the analysis.

The Measles and Rubella Initiative, a collaboration of international organisations including the WHO, said the decline in measles deaths was strong up to 2007, but measures “faltered” in 2008 and 2009.

This lead to outbreaks in Africa, Asia and even Europe.

Africa and India accounted for a combined total 79% of all deaths from measles between 2000 and 2010.

Measles is a highly infectious viral illness:

Causes a fever, coughing and distinctive red-brown spots on the skin

Contracted by breathing in tiny droplets created when an infected person coughs or sneezes

Possible complications include pneumonia, ear and eye infections, and croup

Serious complications include inflammation of the brain (encephalitis), which can be fatal

Fears are being raised that new 5p and 10p coins which are being introduced into circulation could cause skin problems.The coins are made from steel but plated in nickel, replacing the current cupro-nickel version which contains 75% copper and 25% nickel.

Dermatologists told the British Medical Journal the move could cause problems for people who have nickel allergies, including some people with eczema.

But the Royal Mint said the change would not have an adverse impact.

The new coins, which come into circulation in the next few months, are being introduced because of the rising cost of copper.

The Treasury believes it could save £10 million a year, although millions more have been spent changing vending machines and parking meters as the new coins are slightly thicker, causing anger among councils and industry.

Up to 10% of the population, predominantly women, are thought to be affected by nickel allergy.

The latest controversy has been raised by dermatologists from St John’s Institute of Dermatology in London and the Royal Hallamshire Hospital in Sheffield.

The authors warned that there had been no health assessment of the new coinage.
In comparison in Sweden its central bank, the Swedish Riksbank, has recently concluded that nickel-plated coins “pose unacceptable risks to health”, the BMJ reported.

In a letter to the BMJ, the dermatologists said there was the potential for more skin problems, which could have financial implications for the NHS.

They said: “Considerable evidence supports these concerns, which have not been assessed by the Treasury or Royal Mint.”

They have called for Sir John Beddington, the government’s chief scientific adviser, to look into the matter.

Planned births at home and in midwifery units are more cost-effective than giving birth in hospital, particularly for women who have given birth before University of Oxford research concludes.The research, in the British Medical Journal, compared the costs of giving birth in different places and the health outcomes for mother and baby.

More than 60,000 low-risk women in England were studied over two years.

The Royal College of Midwives says all women should receive one-to-one care.

For women having their first baby, however, planned home birth was more risky for the baby but still the most cost effective option.

The study used data from the Birthplace in England national study to calculate the cost, and health effects, of women at low-risk of complications giving birth.

It looked at planned births in obstetric units, midwifery units located in the same hospital as an obstetric unit, free-standing midwifery units not in a hospital and at home.

The study takes into account all NHS costs associated with the birth itself – such as midwifery care during labour and immediately after the birth, the cost of pain relief in hospital, and the cost of any stay in hospital or neonatal unit immediately after the birth, either by the mother or the baby.

The costs for planned home and midwifery unit births take account of any hospital care a woman may receive if she is transferred into hospital during labour or after the birth.

But the costs do not include any longer term costs, for example the life-long cost of caring for babies who suffer serious birth injuries.
The study found that the average cost per low-risk woman planning birth at the start of labour was £1,631 for an obstetric unit, compared with £1,067 at home.

When the researchers analysed women who had already given birth or who had no complicating conditions, the cost differences between planned places of birth narrowed.

The authors of the study conclude that giving women the opportunity to give birth at home or in a midwifery unit saves the NHS money and is safe for baby and mother, resulting in fewer expensive interventions.

AVERAGE COST OF BIRTH

£1,066 – births planned at home

£1,435 – births in freestanding midwifery units

£1,461 – births in midwifery units alongside hospitals

£1,631 – births in hospital obstetric unitsSource: BMJ study

The study found that individual care at home is cheaper than a planned hospital birth because hospital overheads tend to be higher and women who plan birth in an obstetric unit tend to have more interventions, such as caesarean section, which are expensive.

A faulty gene that increases the chances of breast cancer in women has been found to raise the risk of prostate cancer in men four fold.Men with a strong family history of either cancer in their family could be offered genetic tests to discover if they are carrying a faulty BRCA1 gene so their health can be monitored from an early age.

Men with the BRCA1 gene have a one in 11 chance of developing prostate cancer by the age of 65, it was found.

The faulty gene seemed to be linked to a particularly agressive form of cancer making early detection and treatment vital.

The study was conducted by the The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust and published in the British Journal of Cancer.

In breast cancer BRCA1 increases the chances of developing the disease by five fold, giving them a six in ten chance of breast cancer compared with a one in eight chance for healthy women.

It has led some women with faulty genes to have preemptive mastectomies rather than live with high risk of breast cancer. BRCA1 is also associated with ovarian cancer.

In the study 913 men underwent genetic screening, with results obtained from 886 and four men were found to have alterations in BRCA1. Three out of those four men were diagnosed with prostate cancer before the age of 65.

As well as detecting BRCA1 in men with a history of cancer in their families to identify those at greater risk, genetic screening of men who already have the disease could improve their treatment, the researchers said.

There are already drugs in use that target BRCA1.

The findings come after other research showed that HIFU (high intensity focused ultrasound) can provide the ‘perfect’ outcome for nine out of ten men with early stage prostate cancer. The majority of men treated were continent, had good sexual function and were free of cancer after 12 months where as traditional surgery or radiotherapy could only offer that in half of cases.

Prostate cancer is the most common cancers affecting men in Britain with 37,000 men diagnosed each year. It claims 10,000 lives every year.

Other faulty genes have been implicated in prostate cancer including a mutation in HOXB13 which increased the risk of the disease 20 fold. It is relatively rare, occuring in less than two per cent of men with prostate cancer.

Having a positive attitude to life may reduce the risk of having a heart attack or stroke a major review of research has found.People who are able to enjoy simple pleasures, have a sunny disposition and positive outlook on life are less likely to have heart attacks and strokes, it has been found.

It was known that stress and depression increase the chances of being unwell and is harmful for the heart but less was known about how positive emotions affect health.

In the first review of its kind, a team at Harvard School of Public Health, in Boston, America, examined 200 separate research studies which looked as psychological wellbeing and cardiovascular health.

The findings were published online in Psychological Bulletin.

Lead author Julia Boehm, research fellow in the Department of Society, Human Development, and Health at HSPH said: “The absence of the negative is not the same thing as the presence of the positive. We found that factors such as optimism, life satisfaction, and happiness are associated with reduced risk of cardiovascular disease regardless of such factors as a person’s age, socioeconomic status, smoking status, or body weight.
“For example, the most optimistic individuals had an approximately 50 per cent reduced risk of experiencing an initial cardiovascular event compared to their less optimistic peers.”

Each of the 200 research papers studied slightly different emotional states using questionnaires and assessments to score individuals’ characteristics and outlooks.

They measured the extent to which individuals consider themselves a happy or unhappy person, satisfaction with their life and the extent to which they experience pleasurable feelings.

Some also looked at optimism and hope, the extent to which individuals have expectancies for positive outcomes in the future and enthusiasm for life.

Senior author Laura Kubzansky, associate professor of society, human development, and health at Harvard, said there are psychological assets, like optimism and positive emotion, that afford protection against cardiovascular disease.

These factors protected people against heart attacks and strokes and also slowed the progression of heart disease and other diseases in patients who had already developed them, it was found.

The research showed that people with a positive outlook on life and who were optimistic about the future tended to lead healthier lives overall.

They were more likely to exercise, eat a good balanced diet, and get enough sleep. Yet even when these factors were accounted for, the happier people were still less likely to develop cardiovascular disease.

It is thought that a positive attitude to life makes people more resilient to stress and helps them recover more quickly after things like preparing for a speech, the researchers said.

In one study that was examined, involving 300 men and women having bypass surgery, those with an optimistic outlook were also 50 per cent less likely to be admitted to hospital for heart problems or surgery complications six months later.

Prof Kubzansky said if future research continued to indicate that higher levels of satisfaction, optimism, and happiness proceeded good cardiovascular health, it would have strong implications for the design of prevention and treatment of heart disease and stroke.

The review found that one study of nearly 2,500 men and women showed that emotional wellbeing, as rated on a depression scale, was linked with a 26 per cent reduced risk of stroke six years later, even after accounting for traditional risk factors and negative mood.

There were similar results on scores of vitality, even after accounting for factors that cause heart disease such as smoking and obesity, it was found emotional vitality was associated with a 28 per cent reduced risk of coronary heart disease.

Some health authorities are spending less than a pound a day helping people with arthritis and other joint problems, while others spend three times that, according to a review that has found a postcode lottery of care.The survey by the Arthritis and Musculoskeletal Alliance (ARMA) has found an almost three-fold variation in the amount of money primary care trusts across England spend on services.

NHS Hartlepool spent £764 per patient in 2009-10, but NHS Peterborough only £275.

Examples of treatments they offer include physiotherapy, drugs, and pain management clinics.

The figures are detailed in a new report by ARMA, called Joint Delivery?

Professor David Marsh, chairman of the organisation, said: “Joint Delivery? shows that progress in delivering improved musculoskeletal care in the NHS has gone into reverse since ARMA’s previous audit in 2008.

“Urgent action is now needed to address variations in service provision and improve the quality of musculoskeletal services in the NHS.

“ARMA and its members are taking a lead by developing a musculoskeletal clinical network to improve services but we need national action to make musculoskeletal conditions a priority in the new NHS.

“That is why we are today calling for a national outcomes strategy for musculoskeletal conditions to ensure services deliver better outcomes for patients.”

At the moment about five per cent of the total NHS budget, some £4.76 billion, is spent on musculoskeletal conditions, making it the fourth highest area of programme budget spend.

Although spend had “risen rapdily in recent years”, according to ARMA, it warned that the area was at risk of being downgraded, with two-thirds of PCTs saying they had reduced the number of specialist commissioners who decide on care